CENTRAL APNOEA

[Pedrx]

Can you please advise on the following issue.


Have been using, for several years, a pillows device as the ResMed machine describes it, and seeing readings below 5.
Recently however the reading have increased to between 10 and 20 of what appears to be Central Apnoea.

No change in medication, pressure or any other aspect I can think of.

Have since bought and used both a nasal and a hybrid nasal mask. Neither affected the central apnoea reading of 10 to 20.
So tried a full face mask and readings returned to normal of 5 or under.

I believe Central Apnea may be caused by the use of CPAP machine? Then perhaps the brain perceives the full mask differently?
I tried the pillows mask recently for one night and the reading returned to 11. 

A possible cause: I notice air leaking from the nose through into the mouth. It gurgles through as though the flesh is acting as a valve which collapses under pressure. This was while still awake so what goes on when asleep I wonder. It doesn't occur on the down facing cheek which is compressed against the pillow.

I can do an Oscar reading if this would help. Perhaps one each, with Pillows and full face mask?

Also can you please explain the three ResMed Air-sense readings: AHI - TOTAL AI - CENTRAL AI. There appears little correlation between the numbers. Other than the TOTAL is an average of the other two.

[OpalRose]

I can do an Oscar reading if this would help. Perhaps one each, with Pillows and full face mask?

Also can you please explain the three ResMed Air-sense readings: AHI - TOTAL AI - CENTRAL AI. There appears little correlation between the numbers. Other than the TOTAL is an average of the other two.

AHI (Apnea/Hypopnea Index)

AI (apnea index) The sum of Obstructive Apnea and Central Apnea "divided" by the hours of sleep.

Total AI (Apnea Index) Number of Apneas per hour of sleep.

And yes, please post some OSCAR charts, one with "pillows" and one with "full face" mask.

[Gideon]

Do post your OSCAR data.

[Pedrx]

[attachment=37830]         Oscar shots as suggested. They are chosen to demonstrate the issue described and may not reflect current readings which, using full face mask, are consistently reasonable.

[Sleeprider]

In your selected image there is a great deal of noise created by large leaks. A graph showing the leaks would be helpful to include in this case rather than tidal volume or respiration rate. We prefer to see flow rate, events, pressure or mask pressure, leaks and flow limitations. It would probably be best to not only focus on an issue of concern, but to include currently typical results. This brief glimpse at one night shows the first sessions is fairly quiet, and the events and leaks become a significant problem later in the night. This may be due to positional issues causing mask leaks and airway obstruction, or it may be a component of your sleep architecture. This is just insufficient to judge, especially with the selected graphs.

Take a look a the Organize Your Oscar Charts wiki linked in my signature.

[SarcasticDave94]

In this last thread of yours http://www.apneaboard.com/forums/Thread-...om-5-to-25, from 5/30/2020, Sleeprider pointed out almost all Central Apnea events in your data. Given that in the past and present there's higher CA levels, I suggest getting a ResMed AirCurve 10 ASV. By high level of CA, I'm meaning 50% or more consistently.

Central Apnea will regularly be consistently inconsistent, varying degrees of up and down. The ASV is the tool that will combat the CA successfully. So far your therapy devices are only able to avoid Centrals. And there's proof the Avoidance Method is not working.

[Pedrx]

As described in my post from 2020 the ''Central''  began and ended during the period I started and stopped taking co-codamol. There has definitely been no medication around this new series of CA events.

The higher readings of the 2 new screen shots are of course using the Pillows mask. It may help to check the opening thread: the purpose of the discussion being to perhaps throw some light on why the CA events have suddenly occurred. Is my theory plausible perhaps?

I would prefer not to produce current PILLOWS data: CA seems to have a more profound adverse effect than Obstructive events, but will do so if you think it will help. Yes, the CA may have disappeared after a week or two using full face mask - which, my newly adapting to, is probably causing the high leakage - but then there would be no data to learn from?

Thank you for your prompt attention so far. Peter

[Sleeprider]

Since you no longer take the co-codamol, and central apnea seem to be much less, would you like to try some EPR to reduce the flow limitations? If so, just turn on EPR and try setting 1, 2 or 3. Your clusters of OA are positional as I said before, and you are tucking your chin as a result of pillows too tall, sleeping position or some other cause. You may need a soft cervical collar.

I would like to merge your therapy threads into one to avoid confusion or giving you conflicting recommendations. Here is a link to the other thread. Would you object to merging? http://www.apneaboard.com/forums/Thread-...om-5-to-25

[sheepless]

you're in good hands with the previous respondents so stick with them. I'll toss in my 2 cents, fwiw.

there's a lot going on in your charts. among other things, your leaks are driven by increasing pressure which is the machine responding to flow limitations. pressure can also cause centrals (ca). I don't know your history with ca but if you think they were caused by meds and you're not taking them any longer, the current crop may be pressure induced.

the first thing I would do is reduce max pressure to reduce leaks and possibly ca. then, if you can tolerate epr without increasing ca, I'd try that to reduce your flow limitations, which in turn may allow you to increase your max pressure if necessary, but I'm thinking you may not need to.

there's too much "csr" or periodic breathing in the older screenshot. do you see that very often? post a 10 minute segment from a green area for the experts to determine if it's csr (potentially problematic) or periodic breathing (usually benign).

[SarcasticDave94]

What a buffet of events. OA clusters, CA mess, leaks, CSR flags probably the false flagged ones. Wonder what we'll see when the dust settles.